Tulane Outbreak Daily | April 1, 2020

Coronavirus Task Force Details ‘Sobering’ Data Behind Its Extended Guidelines – NPR  “As sobering a number as that is, we should be prepared for it,” said Dr. Anthony Fauci, a top immunologist helping to steer White House policy on the disaster. “No one is denying the fact that we are going through a very, very difficult time right now.”
Wastewater test could provide early warning of COVID-19 – Science Daily  Researchers are working on a new test to detect SARS-CoV-2 in the wastewater of communities infected with the virus. The wastewater-based epidemiology (WBE) approach could provide an effective and rapid way to predict the potential spread of novel coronavirus pneumonia (COVID-19) by picking up on biomarkers in feces and urine from disease carriers that enter the sewer system.
Covid-19 — Navigating the Uncharted – NEJM [Editorial by Fauci, Lane, Redfield] Covid-19 was recognized in December 2019.1 It was rapidly shown to be caused by a novel coronavirus that is structurally related to the virus that causes severe acute respiratory syndrome (SARS). As in two preceding instances of emergence of coronavirus disease in the past 18 years2 — SARS (2002 and 2003) and Middle East respiratory syndrome (MERS) (2012 to the present) — the Covid-19 outbreak has posed critical challenges for the public health, research, and medical communities.
Because of age, third of US doctors prone to worse COVID-19 – CIDRAP  Nearly one in three licensed doctors in the United States is older than 60 years, an age-group particularly vulnerable to adverse outcomes from COVID-19, according to a study published today on the preprint server medRxiv. And New York and California, two hard-hit states, have the most older physicians.
Infected but Feeling Fine: The Unwitting Coronavirus Spreaders – NYT  The C.D.C. director says new data about people who are infected but symptom-free could lead the agency to recommend broadened use of masks.
Who’s Sickest From COVID-19? These Conditions Tied To Increased Risk – NPR  A new analysis from the Centers for Disease Control and Prevention finds people with chronic conditions including diabetes, lung disease and heart disease appear to be at higher risk of severe illness from COVID-19. [Related CDC Report]
No cases of COVID-19 where you live? You should still stay home. – Popular Science  “Stay home! Even if you think it is not in your area, take serious precautions. Go out when you absolutely have to. Try to do errands once a week instead of a little every day,” Charlotte Baker, an epidemiologist at Virginia Tech in Blacksburg, advised in an email to Popular Science. “Staying home now will help reduce how the outbreak affects your area. It really works but everyone has to do their part.”
Outbreak On U.S. Aircraft Carrier ‘Accelerating,’ Commander Warns Pentagon – NPR  The commander of an American nuclear-powered aircraft carrier docked in Guam that has been struck by a coronavirus outbreak has sent the Pentagon a strongly worded plea for urgent assistance. “The spread of the disease is ongoing and accelerating,” USS Theodore Roosevelt commander Capt. Brett Crozier writes in a letter dated March 30. “Decisive action is required now in order to comply with CDC and [U.S. Navy] guidance and prevent tragic outcomes.”
Coast Guard: Cruise ships must stay at sea with sick onboard – AP  The U.S. Coast Guard has directed all cruise ships to prepare to treat any sick passengers and crew on board while being sequestered “indefinitely” offshore during the coronavirus pandemic. The new rules require daily updates on each ship’s coronavirus caseload for vessels in U.S. waters, and come with a stiff warning: Any foreign-flagged vessels “that loiter beyond U.S. territorial seas” should try first to medically evacuate the very sick to those countries instead.


Editor’s note: Regarding the case counts below, please consider due to limited testing capabilities in some locations, the real number of cases could be considerably higher.

Official Reporting for April 1, 2020

  WHO SITREP #71 ECDCCountry Data Johns Hopkins
Confirmed Cases 750,890 85,3200 874,081
Deaths 36,405 41,887 43,291


Total cases: 163,539
Total deaths: 2,860
Jurisdictions reporting cases: 54 (50 states, District of Columbia, Puerto Rico, Guam, and US Virgin Islands)

Travel Related: 1,042
Close Contact: 2,919
Under Investigation: 159,578
Total Cases: 163,539

Surveillance Headlines


Texas: 28 University of Texas spring breakers test positive for COVID-19 after group trip to Mexico – NBC News

North Carolina: 1,584 people have coronavirus in North Carolina, 9 deaths reported – Local News


France:  Reported 7,578 new cases, with a total of 52,128. Health officials also reported 499 more deaths, which increased the country’s fatality count to 3,523, making it the fourth country to pass China’s death toll. – CIDRAP

Italy: Reported 4,053 more cases, with a total of 105,792 cases. An additional 837 were reported, bringing total to 12,428. – CIDRAP

UK:  Reported 3,009 more cases, 381 more deaths. CIDRAP

Turkey: Reported 2,704 cases, up dramatically from the 1,610 it reported yesterday. Total deaths reported 168. CIDRAP

Serbia: Serbian state secretary dies from coronavirus – Reuters

Germany: Mass testing, empty ICUs: Germany scores early against virus – AP

Middle East

Iran: Reported 3,110 new cases, and 141 new deaths, with respective totals of 44,605 and 2,898. CIDRAP


Philippines: Reported 538 new cases, with a total of 2,084 cases, with 88 deaths. CIDRAP

India: Reported 146 new cases, for a total of 1,397. CIDRAP

Japan: Reported 87 new cases, total is 1,953. CIDRAP

South Korea: Reported 125 more cases, totaling 9,786. CIDRAP

Singapore: Reported 47 new cases, 16 of them imported, and Hong Kong reported 32 new cases, 24 of them with a travel history.


Science and Tech


The $1 billion bet: Johnson & Johnson (Janssen Division) and Biomedical Advanced Research and Development Authority (BARDA) team up in all-out coronavirus vaccine push – Science  Janssen’s vaccine is built around an engineered version of adenovirus 26 (Ad26), which normally causes common colds but has been disabled so that it cannot replicate. Company scientists stich into this Ad26 “vector” a gene for the surface protein from the new coronavirus spreading around the world. Janssen is testing this same Ad26 platform in vaccines against Ebola, HIV, respiratory syncytial virus, and Zika. J&J had $42 billion in pharmaceutical sales last year, making it the sixth largest big pharma company. Sanofi is the only other in the top 10 that has a COVID-19 vaccine project.


Newly approved testing at Tulane, UMC gives coronavirus results in hours – WWLTV

Published Research

SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients – NEJM

Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany – NEJM

Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia – NEJM

Use of Hydroxychloroquine and Chloroquine During the COVID-19 Pandemic: What Every Clinician Should Know – Annals of Internal Medicine

Epidemiology, genome and clinical features of the pandemic SARS-CoV-2: a recent view – New Microbes and Infections

Chest Radiographic Findings of Patients Infected with 2019-nCOV – International Journal of Multidisciplinary Health Sciences Research

2019-ncov’s epidemic in middle province of northern Italy: impact, logistic & strategy in the first line hospital – Disaster Medicine and Public Health Preparedness

Clinical and immunologic features in severe and moderate Coronavirus Disease 2019 – Journal of Clinical Investigation

Antibodies in Infants Born to Mothers With COVID-19 Pneumonia – JAMA

Cutaneous manifestations in COVID‐19: a first perspective – Journal of the European Academy of Dermatology

Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic – NEJM

Pre-Pub (not yet peer reviewed, should not be regarded as conclusive) 

Susceptibility of ferrets, cats, dogs, and different domestic animals to SARS-coronavirus-2 – BioRX

Extra Corporeal Membrane Oxygenation for 2019 novel Coronavirus Acute Respiratory Disease – University of Queensland, Australia

Economic Impact

Screening for Previous Virus Infection Could Unlock Work Force – BloombergNew blood tests from Henry Schein Inc. and Becton Dickinson Co. look for antibodies produced in the middle to late stages of infection with Covid-19, the respiratory illness caused by the new coronavirus. Determining whether people have been infected could allow them to return to work without fear of passing along the disease or contracting it.


Opinions & Editorials

What it’s like being a New York ER doctor during this pandemic – Washington Post  Craig Spencer is director of global health in emergency medicine at New York Presbyterian/Columbia University Medical Center. NEW YORK — Wake up at 6:30 a.m. Priority is making a big pot of coffee for the whole day, because the place by the hospital is closed. The Starbucks, too. It’s all closed. On the walk, it feels like Sunday. No one is out. Might be the freezing rain. Or it’s early. Regardless, that’s good. Walk in for your 8 a.m. shift: Struck by how the calm of the early morning city streets is immediately transformed. The bright fluorescent lights of the ER reflect off everyone’s protective goggles. There is a cacophony of coughing. You stop. Mask up. Walk in. You take sign-out from the previous team, but nearly every patient is the same, young and old: cough, shortness of breath, fever. The staff is really worried about one patient. Very short of breath, on the maximum amount of oxygen we can give, but still breathing fast. [If you hit a paywall at the link, try here]